Evaluates, executes, conducts high level review and analysis, and/or leading and closing value-based contract negotiations with larger and more complex, national-based group/system providers as well as support local market/regional contract managers in accordance with company standards in order to maintain and enhance provider networks around value-based contracting. Meets and exceeds accessibility, quality, performance and financial goals and cost initiatives. Leads work and deliverables of multiple, complex projects/programs, through assessment to implementation, that impact multiple processes, systems, functions, and products across all lines of business. Length of project may run multiple years in duration.
Evaluates, executes, conducts high level review and analysis, leading and closing value-based contract negotiations, and/or documents resulting arrangement of contracts with larger and more complex, national-based group/system providers as well as support local market/regional contract managers in accordance with company standards in order to maintain and enhance provider networks around value-based contracting. Manages contract execution, performance, supports the development and implementation of value based contract relationships, serving as SME in support of business strategies. Complete negotiations where necessary, either at the national level or local market level, as needed and directed. Support generating, editing, or developing content/materials for various deliverables on specific VBC programs, such as contracting guidelines. Helps to transition and convert existing contracts into new arrangements and models as well as any contracts for pilot sites, where necessary. Develops relationships with providers and executes on go-to-market strategies and tactics, as needed, to ensure attainment of network expansion and adequacy targets for relevant VBC contracts. Collaborates cross-functionally with various stakeholders locally and nationally to manage contract execution, submission of contractual information, and review/analysis of reports as part of negotiations and payment model activities. Partners with other functional managers, business areas across/within segments or lines of business to ensure all workflow processes and interdependencies are identified and addressed. Provides network development/expansion, maintenance (e.g., provider lists), and refinement activities in support of cross-market network management. Assists with design, development, management, and/or implementation of strategic network configurations and integration activities. May optimize interaction with assigned providers and internal business partners/local contract managers to manage relationships to ensure provider eligibility, competency requirements, and needs are met. Ensures resolution and documentation of escalated issues related, but not limited to, value-based contract deal terms, claims processing/implementation, contract interpretation and parameters, and/or accuracy of provider entity information. Meets and exceeds accessibility, quality, performance and financial goals and cost initiatives. Actively engaged with any necessary trainings and operational work flows, such as SME on contract guidelines for outreach and go-to market strategies, contract definitions (inclusions, exclusions, parameters), contract processing (reconciliation, settlement follow-ups), and other content/knowledge base as appropriate.
Ability to communicate effectively with all levels of management.
Proven ability to satisfy customers needs and develop alternatives to resolve issues.
8-10 years of related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with individual or complex provider systems or groups (inclusive of 3-5 years of value-based experience, preferred but not required).
Proven working knowledge of provider contracting, financial, competitor strategies, complex contracting options, financial/contractual arrangements, and regulatory requirements.
Strong communication, critical thinking, problem resolution and interpersonal skills.
Strategic, and a good communicator
BS/BA or equivalent experience and 8-10 years of contracting experience specifically in Value-Based Care (preferable).
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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